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Will You Lose Medicare or Medicaid If You Leave the Nursing Home to Visit Family?

October 30th, 2017

Reunions, graduations, birthdays, and holidays: Whatever the occasion, nursing home residents don't want to miss out on family gatherings, but may be afraid that they will lose Medicare or Medicaid coverage if they leave the nursing home. In most cases, Medicare recipients can leave for a day or two, although the nursing home may bill them in order to hold their beds. Medicaid recipients will need to check with their state.

Medicare's coverage of nursing home care is quite limited and it only covers "skilled care" – i.e., treatment provided by a doctor or nurse. Coverage can stop if a patient is no longer benefitting from this skilled care. However, the Medicare policy manual states that a short leave of absence to attend a family occasion is not, by itself, evidence that the resident no longer needs to be in the nursing home. The manual also states that staff should not tell a resident that leaving the facility will cause coverage to lapse.

Margaret A. O'Reilly, PC

Margaret A. O’Reilly is an estate planning and elder law attorney with over thirty-five years of legal experience. Attorney O’Reilly graduated from Duke University with a degree in psychology, and received her law degree from Northeastern University School of Law in Boston, Massachusetts. For over 15 y...

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Daniel N. Steven, LLC

Daniel N. Steven is an attorney licensed in Maryland and the District of Columbia. with many years of experience in complex estate planning and Elder Law. He is rated by Martindale-Hubbell as an AV Preeminent 5.0 out of 5 rated attorney.

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For Jeffrey Hammond, the practice of Elder Law is personal. Jeff’s many years of experience in law and in business did not prepare him for the crisis he faced in 2005 and 2006 when his father suffered a stroke and both of his parents suffered from dementia and other medical problems. At that time, Jeff began an i...

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If a resident leaves and returns by midnight the same day, the nursing home can bill Medicare for the day. However, if the resident is gone overnight, Medicare will not compensate the nursing home for the time missed. If the resident wants to leave for a few days, he or she should check with the nursing home to make sure the bed can be held. The nursing home may charge the resident a bed-hold fee in order to keep the space available.

If a Medicaid recipient leaves a nursing home to visit family, it is called "therapeutic leave." State laws regarding therapeutic leave vary widely. Some states will pay to hold a bed for as long as 30 days a year, while others pay nothing at all for such leave. Each nursing home is required to provide residents with information about their bed-hold policy before the resident leaves the facility. In addition, if a Medicaid recipient is absent longer than the nursing home's policy allows, federal law requires the nursing home to readmit the recipient to the first available room. For a list of state bed-hold policies, click here.

If a nursing home gives a resident a hard time about leaving for a few days, the resident should contact his or her attorney.

For more information about Medicare's nursing home coverage, click here.

For more information about Medicaid’s long-term care coverage, click here.